To what factors do clients attribute change? Content analysis of follow-up interviews with clients of the UK Alcohol Treatment Trial

The UK Alcohol Treatment Trial compared outcomes after a social treatment (Social Behavior and Network Therapy) and a motivational treatment (Motivational Enhancement Therapy). As part of the process element of the trial, a subsample of clients were interviewed 3 months after treatment allocation and another subsample 12 months after allocation (N = 397) to explore the factors to which clients attributed positive changes that might have occurred in their drinking. Postinterview reports were content analyzed using three types of code: social, motivational, and general. At 3 months, Social Behavior and Network Therapy clients made significantly more social attributions and Motivational Enhancement Therapy clients more motivational attributions, and the difference for motivational attributions was maintained at 12 months (with a trend for social attributions). Overall, the factors to which change was most frequently attributed were involvement of others in supporting behavior change (a social factor), awareness of the consequences of drinking (a motivational factor), and three general factors--determination, commitment, and decision; detoxification or medication; and feeling comfortable talking. Change was more frequently attributed to general factors than it was to either social or motivational ones. Some of the difficulties in eliciting and coding attribution material are referred to. The results may help understand the absence of between-treatment type outcome differences in UK Alcohol Treatment Trial and other trials.